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Friday, December 28, 2018

Like Water For Water

With flu season getting ready to come into full swing, and everyone believing they have the flu now that they've spent the holidays with their families, it's to break out the winter advice.
Here is the first of the season.

Original Grandpa: Do you have something over the counter?
CP: Yes. We have lots of things over the counter.
OG: I'm looking for Onti-biotics
CP: There are no antibiotics OTC.
OG: I don't know how to pronounce it.
CP: Then I don't know what you seek.
OG: Os-Cal-Ium?
CP: Yeah. I know what you need, but I'm waiting to see if you pull a muscle.
OG: Ob-ste-tri-cium?
CP: Keep going. This is entertaining.
OG: On-top-of-Old-Smoky?
CP: Oooh. Onomatapoeia?
OG: No. I give up.
CP: Bummer. I bet it's oscillococcinum.
OG: Sounds better when you say it.
CP: Practice. Shall I find it for you?
OG: Yeah. I don't know where to look or what it looks like.
CP: Or how to say it, or anything else about it so let's run to the pharmacy and get it. Here it is. Now buy it.
OG: I was hoping you had an off-brand.
CP: We do.
OG: You do?
CP: Yep.
OG: What is it? I'll take that.
CP: Hold out your hands.
OG: Okay.
CP: <pours air from my cupped hands into his cupped hands, careful not to spill any> Now take a deep breath. If you like, I can sell you a bottle of water to wash it down.
OG: Hmm. Maybe I'll just stick with the name brand.
CP: Suit yourself. It's your money.

Monday, December 10, 2018

A Little Thought Exercise

Have you ever completed this exercise? I've seen it used during childbirth classes in particular. You start with all the important things you want for your baby and eliminate one thing at a time until you arrive at the most important. This is usually "A Healthy Baby"; sex, hair and eye colour, etc don't matter, so long as the baby is healthy.

I was thinking about this when my staff and I were recently trying to prioritise the tasks ahead of us for the day.
(It was a busy time and the corporate metrics were nagging the backs of our skulls.)

We had prescriptions to type.
We had prescriptions to fill.
We had prescriptions to check.
We had calls to make to offices and patients.
We had returns to stock to complete.
We had an order to shelve.
We had shots to push, and administer.
We had phones to answer.
We had patients picking up prescriptions at the counter.
We had pickups at the drive thru.
We had drop offs at the window.
We had all the other crap to do that each company requires.

We were short-staffed, as always.
As my techs and intern were asking what to do next, (we were behind on wait times) I replied calmly with:
"The prescriptions. Spend your time and effort on the data entry, on the filling, and on the accuracy required of both. I will focus on checking them and making sure we don't kill anyone."

At the end of the day, after eliminating all of the "important things" from our pile, when we come to the MOST IMPORTANT item, should it be
a.) correct Rxs with safe, happy patients or. . .
b.) metrics?

In case you need help deciding what to do next, look at this list and the most important item shall become clear.
I get annoyed when I occasionally fill in at other stores and we are in the weeds with prescriptions (>1hr behind) and someone decides he is going to pull returns or outdates or make courtesy refill reminder calls. Dude, you are doing the wrong work at the wrong time. If we get caught up on prescriptions, you can do the other stuff. It's not going anywhere.
Those tasks can wait.
Those tasks can't call the 1-800-I-HATE-YOU complaint number.
Those tasks won't be affected by a misfill.

At the end of the day, our job is to make sure the correct prescription is filled correctly for the correct patient with the correct medication, correctly. Period.
When corporate asks why your other tasks are lagging, tell them they can pick which day you stop filling prescriptions correctly.
"How about next Tuesday? We can all work on everything else, except filling prescriptions correctly or, at all. How's that? We will change Taco Tuesdays to Task Tuesdays. Or, short of that, you could give me enough tech help to do all of it simultaneously. Your choice."


A little thought exercise. You write down each of the things that are important in your life on these little cards. Then you eliminate one card at a time until you get to the one that that's most important to you.


Tuesday, December 4, 2018


Dear CP, 
Honest question, but please post anonymously if you are able... In what universe is it more cost effective to leave open bottles of medicine on the shelf until they expire simply because they are non-preferred? I cannot see how this is more profitable than using the drugs already on hand.

Good question. Here are my two cents.
I cannot understand why/how a company would not want to decrease its inventory by dispensing all of its partial inventory. Everywhere I have worked, I have been able to dispense a partial/completion to remove these little bastard open bottles from my shelves. If your company does not, why not?

I worked for an independent and discussed the inventory issue with her. At one point she had 3 open bottles on her shelf, each one contained 10 tablets. There is no way to properly dispense these to the patient. (Can't do 3 partials on a fill.) Had she performed a partial/completion when the new NDC arrived each time, this would not be an issue. Instead, she has 3 open bottles that are eating up her inventory.
Another company has individual stores with over $1 million in EXCESS inventory. Some of it is partial and non-preferred bottles. If the company took time to reallocate this inventory (or just dispense it) instead of letting it expire, they could afford to hire 7 pharmacists; just based on the inventory at this one store. (Let that sink in for a moment.)

Yes, the reality today is that companies do not make deals with the wholesalers like we used to do. Add in temporary (and long-term) backorders and we sometimes have 7 or 8 NDCs on the shelf for any given product. It's dead inventory unless/until we get it again.

Why is there not a way to use this effectively? Why would we want to allow these products to die? We already paid for them. It's like accidentally buying brown eggs instead of white and allowing them to go bad in your fridge, or just tossing them altogether. You've already paid for them. It is literally throwing money away to not use them.

The only answer I can offer is time. It takes longer to do the right thing than the easy thing.

What say you?

Monday, December 3, 2018

This Is Not A Negotiation

Wildly Imagining My Partaking, Yes?: Hello. I have a question for you.
CP: I love questions. Do I have to reply with "I have an answer for you" before I respond? Or can I just give you my answer without a preface?
WIMPY: I suppose either would work. 
CP: Then fire away my good man.
WIMPY: I wish to receive a 90 days supply of my medication.
CP: That's a statement.
WIMPY: However, I only have enough money for some of it now.
CP: Another statement. <taps fingers on counter>
WIMPY: What?
CP: This is like learning German; I'm waiting for the verb.
WIMPY: Can I get my whole 3 month prescription up front and make payments every week?
CP: Like an installment plan? Or layaway?
CP: Please please please quote your namesake for me.
WIMPY: I'll gladly pay you Tuesday for some medication today?
CP: <titters> Worth it.
WIMPY: So you'll do it?
CP: <snickers> Nope. That's like my company paying me on January 1st for an entire year of work and expecting me to show up every week. I'm sure we'd start off the best of friends those first few weeks but by February? You're not returning my calls and texts, your FB status says "it's complicated" and there are pictures of other pharmacies on your Instagram.
WIMPY: What do you suggest?
CP: An installment plan. How about you pay me every week and in exchange, I'll give you medication every week. It's a true win-win. You get medication and I get 52 refills. 

Wednesday, November 21, 2018

These Are Our Terms

I was inspired by this conversation related to me recently: 

"‘I’m sick of making extra trips up here. You all are never open past 6 on the weekend and at Rite Aid someone would sell me my prescriptions even after the pharmacy is closed.’
‘No sir our hours have us closing at 6 both days so I apologize for that inconvenience.’
‘Rite Aid had much better customer service than Walgreens.’
‘Thanks for choosing Walgreens and have a great rest of your day.’
#readthepostedhours #takeyourscriptssomewhereelse #sosickofapologizingforthingsoutofourcontrol"

Fine. He's frustrated with the Rite Aid to Walgreens switch. I get it.
And there are plenty of people forced to use a pharmacy, not necessarily the one of their choice.

However, if you do choose to do business with a new pharmacy, do not blame the workers. Learn to live within the confines they have established.

What really bothers me about people in general is their attitude that we should change our business to accommodate them. If you choose to do business with a company, you have to live within their established operation.
If you leave my pharmacy which is open from 8-10 M-F and 9-6 Sat and Sun, for a pharmacy which is open 8-6 M-F and CLOSED weekends, you cannot complain to the new pharmacy that "my last pharmacy had more convenient hours and you need to change yours to accommodate my needs". You chose to leave convenience for price or quality or whatever reason that felt more important to you.

I recently spoke with a man whose daughter switched schools. The new school required they purchase a specific calculator. He proceeded to send messages to the school complaining there were cheaper versions available; that this expensive calculator ($90.00) was unnecessary for her school (she'd likely use it for the rest of her academic career, including through college); and he shouldn't be forced to purchase it. As I tried to explain to him, YOU chose the school. YOU chose to leave her old school. YOU have to live within the parameters they offer.
You don't get to complain.
Either accept the terms and move on or, simply move. On. . .

The same goes with choosing your pharmacy.
I'm sorry we no longer live in a time when pharmacies (and all retailers, for that matter) were closed on Sundays and Holidays. You had one option if your forgot your prescription refill or the gravy on Thanksgiving - Suck it up, Buttercup.

The best part of living in America right now? The freedom of choice. You can choose to switch pharmacies. 
(But the other one is too far away.) That is still a choice.
(But the other one doesn't take my insurance.) Heard of Mail Order? Maybe change medications and use discount cards?
You can "But But But" all day long, but it doesn't change the fact that you have a choice.
Just don't complain to me about your choice. I didn't make it and I don't care. I have people to help who did choose me and love what I have to offer.
("If you choose not to decide, you still have made a choice.")

Tuesday, November 13, 2018

Don't Break Me Down

CP: Dearly beloved, we are gathered here today to discuss a strange request. 
ME: What now? 
Myself: You need to phind some phriends. These discussions are killing us. 
CP: Well, the issues are killing me so it's only phair I share. 
ME: Phine. What's got your panties in a bundle this week? 
CP: I received a prescription for birth control. 
ME: You're on the pill? 
CP: No, dimwit. At work. It came via e-script for a patient. 
Myself: Makes a whole lot more sense. 
CP: Moving on. It was for 12 tablets. 
ME: Okay. So you fill the pack, she takes the 12 tablets, then tosses the rest. Easy Peasy. 
CP: Except she wanted me to only sell her the 12 tablets. 
Myself: Like, pop them out? 
CP: Exactly. 
ME: How would that work? 
Myself: Do you get to pick which 12 tablets? Like 3 blue, 7 pink, and 2 white? 
CP: Right? They come in a set. 
ME: It's like trying to open a 12-pack of beer. I really only feel like drinking 9 tonight. I'm just going to leave the other 3 here. Can you prorate the cost for me? Thanks. 
Myself: Do people really expect that elsewhere? Like taking 3 rolls of toilet paper out of a 4-pack? 
CP: Well there are the people who only need 2 tablets of Bisacodyl for their bowel preps and don't want to buy the 25-count box. 
ME: Maybe we should just change our business model. We could be the first to open bulk containers and allow patients to purchase only what they need. 
CP: You mean like we already do? With 100-, 500-, and 1000-ct bottles behind the counter? 
ME: No. We open all the packages. Birth control, vitamin drops, OTC products, creams and other topicals, and ooh! inhalers!
Myself: What? How would we do that? 
ME: We just have a community inhaler open at all times. We could charge patients by the puff. 
CP: You've lost it, my phriend. Although we could cut the costs to patients. If each patient had her own MDI (the plastic mouthpiece), we could just insert the canister, allow them their dose of 1 or 2 puffs, then charge them accordingly. 
ME: No cooties! 
CP: Yes. Thank you. 
Myself: So did birth control girl buy the whole pack? 
CP: Yes. She had no choice. I'm not sure why it was an issue anyway. She had no copay on her insurance. I just explained perhaps she'd need it again and would have enough for another round. 
ME: Like buying the full case of beer in anticipation. 
CP: Precisely. Which is what I did after this conversation. 

Thursday, November 8, 2018

A Shot In The Arm

ME: CP, what are your thoughts on this article?
CP: I read the article with interest. Who wouldn't want kids to get vaccines?
Myself: Goats need shots too!
CP: Kids, as in Children. Tiny Humans.
Myself: Of course.
ME: I sense something amiss or you wouldn't be talking to us.
CP: Well, the Senator had me agreeing with him until his brain farted this quote through his mouth: “You’re literally in and out of there in 15 minutes, as opposed to making an appointment with your doctor, waiting an hour, going through all the procedure, and ultimately it’s less expensive," Diegnan said."
Myself: Apparently he didn't speak with any pharmacists about this proposed bill.
CP: It's politics. He came up with a good idea, but ran with it and opened his mouth before researching it.
ME: Did he make sure ALL insurances will cover vaccines for children as young as 3yo at a pharmacy? Did he include language that mandated extra tech help (since many pharmacies have cut tech AND intern hours) during vaccine season? Did he allow pharmacists to receive reimbursement for the extra work through direct billing? (We have had an NPI since we started administering vaccines. Wouldn't it be nice if we could bill the insurance for the administration fee since WE are the ones administering?)
CP: Right. It's great that you're improving access to healthcare. It's tremendous and laudable and you should definitely pat yourself on the back. HOWEVER, do not guarantee how I will do my job, Senator. I'll make you a deal, Senator. Come to my pharmacy. Work with me for a couple hours. I'll show you everything I have to do in a day and you can play tech for me. When you understand my job, then you can tell people how it works. Until you pay me a visit and ask what I want or need, do not open your mouth and speak for me. It's people like you (politicians and prescribers) who speak before thinking and make our jobs more difficult.
ME: Well stated. I'd like to add that, not only should he make sure ALL insurances allow billing of vaccines for children, but that it's easy to bill medical and prescription insurance through any pharmacy. How about mandating that ALL insurances pay for preventive care for ALL patients, regardless of age? I especially like the part where the pharmacists should get paid the administration fee. If we receive prescribing rights, he should ensure that we as pharmacists get the credit for writing the prescriptions as well. I mean, it's only fair since pharmacies are paying some prescriber to use her name as a protocol doctor in many states. Pay me instead, right?
CP: Definitely.
Myself: But what about the poor goats?!


Tuesday, November 6, 2018

How The Retail Mind Warps

When it's been one of those days/weeks/hours and your brain turns to mush. . . 

Monday, November 5, 2018

Shingrix Battle Royale

Uber-Tech: We got Shingrix in today!
CP: Amazing!
UT: What should we do with it?
CP: Ideally we'd administer it.
UT: Right. But how shall we decide who gets it?
CP: Good question.
UT: Call off the list?
CP: The list we shredded a few months ago?
UT: First come, first-served?
CP: Nah. There's no phun in that. People have been acting like asses every time they inquire as to our current stock. We need to exploit this behaviour.
UT: Cage match?
CP: Better.
UT: Gladiator?
CP: I like it. I'm thinking Mad Max Beyond Thunderdome.
UT: Aha. Two men enter, one man leaves!
CP: Can't you just picture it? Throw them all in the Dome and drop their walkers and canes down to use as weapons. I'd be willing to bet they'd get rather creative with their attacks.
UT: Well they have acted quite poorly throughout this whole manufacturer backorder/supply shortage over the last 6 months. They seriously act as though it is life-and-death.
CP: Exactly. Let's run with this. Perhaps we can get GSK to sponsor the Dome. We can hold matches every Friday and Saturday, before the early-bird dinner specials start.
UT: We could even have winner bracket battles for the second shot in 2 to 6 months.
CP: Yes! Repeat business. We could make cult heroes out of the winners; get them a Facebook page and twitter phollowing. We could sell the pay-per-view rights or livestream it in the nursing homes.
UT: Imagine the merchandise. Otto "The Octogenarian" Walkers. Connie "The Cardiac Kid" Canes.
CP: I like it. I think we found our new revenue stream to combat the DIR and PBM fees. We could even extend this to other medications on backorder. "Join us next week when new battles take place for Lorazepam and Methocarbamol!"

Friday, October 26, 2018

A Note To Grumpy Old Farts Pay Attention - Shingrix

It is now the end of October.
Shingrix has been practically unavailable for 6 months now.
The manufacturer can not make enough to keep up with demand. (Despite original statements they had an 18 month surplus, they burned through all stores in 4 months. Oops.)
I can't get it.
My company can't get it.
He can't get it.
His company can't get it.
She can't get it either.
Neither can her company.

So FFS, please stop blaming the pharmacists for the current situation.
Yes, we actually do know how to order products for our patients.
No, apparently you can't understand what every pharmacist has been telling you for months.
It's not US, it's THEM.

It's a shingles vaccine.
I wish you were as dedicated to getting your flu shot and Tdap as you were for Shingrix.
Remember when we had to twist your arm to sell you on Zostavax? Yeah. What changed?

You know how your family loves your wife's signature dish? Everyone asks her to make it for holidays and events? So let's pretend she's in a coma and can't cook.
You still attend all the events sans dish (and wife).
Everyone keeps asking where her dish is. (They don't care about her, they're hungry. They look forward to this dish every Boxing Day and bris and it's not here.)
Could you have made it? No. Why? She has the recipe in her head and you never bothered to help in the kitchen and learn the dish.
Now everyone gets mad at you.
It's not your fault she's in a coma.
It's not your fault you can't cook her signature dish.
Until she recovers, everyone will have to survive without.

Same goes for you and your Shingrix shot. You'll survive without.
When GSK manages to manufacture enough to meet demand, you'll get it.
Until then, STOP. PISSING. AND. MOANING like a 2 year old throwing a temper tantrum.
It's not the pharmacy's fault.
Call GSK.


The next time The Powers That Be solicit ideas for building business (it'll be the first time!), I've prepared my proposal.
A Midway Carnival.

When patients complain that their wait times are too long, what happens? (Correct, bosses cut hours.)
But how do we get the patients to wait patiently and spend more money?
We set up a bunch of booths inside the pharmacy, using pharmacy items, and challenge them to games.

1. The Balloon Dart Throw: Syringes. Step right up and give the kids a few hypodermics and let the good times roll. Employ all the kids asking for syringes for "grandma" and tell them they get to keep the used ones and it's a win-win.

2. The Ring Toss: Patrons will toss vial lids into oversized stock bottles (thinking 1000 ct bottles of Metformin 1000mg or Atorvastatin 80mg).

3. Lite Brite: For the little kids (in all of us) we can set up a giant light wall. The kids will place 60 dram vials in the circular holes over each light and make a pattern. Different colored vials will keep them entertained for seconds on end!

4. Pin-The-Tail-On-The-Doctor: Using pen needles, patients can take out their phrustrations of a long wait on who was really to blame, the doctor's office. Great stress reliever for pharmacy staff as well. (Caricature picture of the prescriber changes hourly/daily.)

5. Knife Throw: Remember those Katana Spatulas I keep making? Spin the wheel and throw the Katana Spatula at the target. Prizes every time!

Think about all the phun everyone will have while waiting for their prescriptions...and all the money they'll spend trying to win the dumb prizes.

Prizes include:
a. Pass to the front of the line on your next visit.
b. 10 minute wait on your next visit.
c. One free argument over your copay.
d. One 3-day supply because you ran out and are going to die.
e. Gift Cards Galore!
f. Pez Dispensers for Prescriptions (one size fits most)

Of course the games will be rigged and no one will win the coveted prizes but, hey, look, your prescriptions are ready!

Wednesday, October 10, 2018

Well, You Asked

CP: Welcome to the first of the month during National Pharmacy celebration time, how may I make a post out of this?
Dude Arguing Full Time: What took you so long to answer the phone?
CP: Good question. Please hold while I check.
<waits 3 minutes, 14 seconds>
CP: I asked my tech and she didn't know why it took so long.
DAFT: That's not good enough!
CP: Hold on, let me check with the pharmacist.
<waits 5 minutes, 42 seconds>
CP: Still there?
DAFT: Yes! What's taking so long?
CP: Still trying to get an answer to your first question. BRB
<<waits 7 minutes, 11 seconds>
CP: Thanks for holding. I think I discovered the problem.
DAFT: And?
CP: See, we're really busy, it being the first of the month and all. It's also the first month of the last quarter of the year which means more people getting 90 days to last through 2018; it's peak flu shot month and all the Q-Tips are coming to get theirs since October is to flu shots as Thursday is to Bingo; I only have 1 technician because corporate believes opening a pharmacy on the first Monday of the month requires only 2 warm bodies; I was on the other line while administering a flu shot from 10 paces with my Phlu-Dart 3001 (better range than the PhluDart 2999); my tech was juggling the register, drop-off, and some magic beans while also placing the phone on hold via telekenesis; and the dog ran away with the spoon. So what do you need?
DAFT: I got a text.
CP: Thanks for calling to tell me. Do you call your friends asking if they got the email you sent?
DAFT: No. It said I am due for a refill.
CP: Okay. And?
DAFT: I need it refilled.
CP: You know you could just reply with a smiley face and it will automatically refill it for you, right?
DAFT: Really?
CP: Yes.
DAFT: Can't you fill it for me?
CP: Sure. Please hold. . .

Tuesday, October 2, 2018

An Ode To Bowel Prep a la Santeria

I don't want no diarrhea
I don't want to poop at all
Twenty-four feet of intestines and I, emptied them all
If I could freeze this crap fest, and my bowels that just won't quit
Well I'd pop a cork in my gut and I'd go no more.

I don't really want to go, no baby, mmmm. . .
And literally all day I'm not fine
Loperamide I need, Oh. . .

My hole will have to withstand this attack, won't leave my heinie all alone.
Intestines gonna die large and small.
I feel the urge, feel the burn, feel the urge and I know I can't stand up.
Whoa, no, huh uh.
Well I swear and cry.

What I really wanna know, please tell me.
Am I really gonna die I know I will, Lytely I'll not Go.
My hole will have to . . .

Oh. . .
But I really want to die, just sayin'
That I really wanna die and it's now time, I won't make it, oh no it's coming out.

The Nulytely will destroy as you run to the bathroom, barricade inside
Death is coming for your insides
And if you can choke it down the end result will be so clear.
Believe me when I say that you need something for that ripped ass.

And I really wanna cry, like crazy
Oh, the inhumanity is mine to face, alone, and I'll take it.
My pride will have to wait, yeah, yeah, yeah.

Monday, October 1, 2018

Doctor Out-Of-Touch

CP: Hello and welcome to CP's Drug Emporium. How may I help you today?
Herr Doctor: I'm a doctor!
CP: Oh shit. Well, as my proctologist always says, relax and it won't hurt as bad.
HD: Huh?
CP: What brings you in today?
HD: I have a dental appointment and need 2 capsules of amoxicillin.
CP: Weird. It's usually 4 capsules but hey, you're a doctor. Are you going to write yourself a prescription?
HD: Huh? No. Why?
CP: Because that's how you get prescription medications; via prescription.
HD: I just need 2 capsules! Why won't you just give them me? I have a bottle of 100 of them at the office I get from McKesson. I have to be at my appointment now and I had to wait 3 months for this appointment!
CP: Wow, doc, you suck at planning. Also, you need to get out more. The world has changed since you graduated. Apparently you skipped the "How the Real World Works" and "Pharmacy, An Introductory Guide" classes and still graduated.
HD: Excuse me?
CP: You're either going to have to write a prescription, then wait while I make a profile for you then fill the prescription, or. . .
CP: Or you're going to have to make that drive to your office then. It looks as if I may be out of Amoxicillin too so your odds aren't good.
HD: This is ridiculous.
CP: Stupid laws. Hate 'em. By the way, where is your office located?
HD: Why?
CP: I'm going to need a physical in the future and figure that, when the urge hit me, I'd just drop by, walk into your office, pass the check in desk, and enter one of your rooms without an appointment. That's how all this works, right?

Some Assistance Required

A Facebook Experiment and Unrealistic Goals (wink, wink corporate America)

I need your help for a project. Next week will mark the anniversary of this page on Facebook. I am attempting a project in order to make a profound, yet definitely-to-be-ignored point. (I'll explain next week.)

For those who don't know, not all of my phollowers see all, or even any, of my posts every week. The only way to engage them all is for you to like and share and post as often as possible.

I currently have 129k phollowers on Facebook.
My goal is to increase that number by ~40% over the next week. This means I would like to have at least 180k phollowers at the end of the project.

What am I asking you do to help?
Here is what I need from everyone:
1. Share this post.
2. Share this with a friend who does not follow me and ask her/him to like my page.
3. Find two favourite posts from the past (because phuture posts aren't yet written) and share them both.
4. Tag your friends in every post you share and ask (beg, wheedle, cajole) them to like and follow The Cynical Pharmacist.
5. Write a recommendation for The Cynical Pharmacist.
6.. Do this every day for the next 10 days.

If my theory is correct, magic will happen and Pink Pharting Unicorns will sprinkle dust all over the world of pharmacy and it will be a happier place.

Remember, the important thing is to share 3 posts every day (the current one plus two older ones) and to beat your friends into submission with requests until they like me.



ME: Okay, CP. What was with the plea last week to gain more followers? 
Myself: Yeah. Was it a crisis? A cry for help? An ego boost? 
CP: Nope. Those are all quite healthy. It was to prove a point. 
ME: What point?
CP: Mind Blowing Thought: If no one is meeting the goals you set, perhaps the goals are unrealistic. 
Let's examine my request. I asked everyone to share my post daily. 
I asked them to share prior posts they enjoyed. 
I asked them to tag friends and beg them to become followers. 
I asked them to write recommendations. 
I asked them to do it daily. 

What Happened?
My goal was too high?
Not everyone followed the directions? (Were they not clear? 

“If words of command are not clear and distinct, if orders are not thoroughly understood, then the general is to blame. But, if orders are clear and the soldiers nevertheless disobey, then it is the fault of their oficers.” Sun Tzu.)

People just didn't want to follow me?
Do they not like me?
Do they already like someone else?

Flu shot goals are unrealistic.
Tech scheduling goals are unrealistic.
The expectation that I could increase my followers by an arbitrary number of 40%, or 52,000 (when I average growing by ~300 per week) is insanely outrageous.
People with either love me or loathe me all on their own.
People will either get flu shots or they won't.

Friday, September 21, 2018

Yes, This Is The Recommendation You Are Looking For

There's a difference between ignoring the advice you sought and arguing with the source.
Angry Little Elf Seeking The One Remedy Miracle: I need your advice. I come here all the time.
CP: What seems to be the trouble?
ALESTORM: I scraped my arm on a screw and now I have this inch wide scrape and I need to know what to do.
CP: Have you had a tetanus shot?
ALESTORM: Why? That's for rusty nails. I put peroxide on it.
CP: Ok. Maybe not the best choice.
ALESTORM: But it fizzed.
CP: Yes. That's the murder of millions of your cells, all screaming in their death throes. Did you try a bandage?
ALESTORM: Yes. But it kept sucking the blood out of me.
CP: Vampire bandage? Made by Lestat?
ALESTORM: What do I do? I'm not going to the ER, my doctor won't call me back, and I need your advice.
CP: Promise to take it?
ALESTORM: Nope. But I'll argue with you if you don't tell me what I don't know I want.
CP: Sounds right. Wash it with water. Pat dry. Place Neosporin Cream on it. Cover it with a bandage.
ALESTORM: But I don't want the bandage to suck out my fluids.
CP: Your wound is weeping. It will weep whether there is a bandage on there or not. This keeps you from moisturizing everything you touch with your flesh wound. Please cover it.
ALESTORM: Do I need waterproof or regular?
CP: Regular is what I handed you.
ALESTORM: But should I get waterproof?
CP: Planning on swimming soon? Getting a fish mani-pedi?
ALESTORM: No. But I'm washing my hair.
CP: Since this is on your forearm, I'd hate to see how you wash your hair if you're going to get this sopping wet.
ALESTORM: I'll take both. You don't know what you're talking about. I don't know what I want and I came here for help and you're not helping me.
CP: My apologies. Please allow me to reiterate and I will be blunt, so there can be no misunderstanding. Go home. Wash your wound. Apply Neosporin. Cover it with a bandage of your choosing.
ALESTORM: What about this other stuff?
CP: Tegaderm? No.
CP: Hydrocortisone? No.
CP: That's the ointment of the Neosporin I gave you.
ALESTORM: It costs more so it must be better.
CP: Yes. At occluding your weeping wound, trapping bacteria, and hastening your demise. Stick with the cream.
ALESTORM: You haven't helped me one bit. I don't know why I come here.
CP: Because your life sucks, you're bored, and you like to annoy and intimidate people so you feel better about yourself for a minute or two?
ALESTORM: How often do I change the bandage?
CP: You've never used a bandage before?
ALESTORM: Not these.
CP: When they are dirty. If they fall off. If they're wet. If you no longer like the appearance of them.
ALESTORM: I'm just taking what you gave me and going home. This was a waste of time.
CP: You can say that again. But at least you got what you didn't know you needed and I got a headache.

Thursday, September 20, 2018

Your Doctor Is A Dick

As a Pharmacist, I have a job to do.
As a Doctor, you have a job to do.
Collectively, our jobs are about Patient Healthcare.
Everything else is about ego and pride.
CMS requires both of us to work together for the betterment of the patient.
(They're called Outcomes.)
Based on your diagnosis, a treatment is selected.
Maybe you missed something.
Maybe you forgot about the use a class of medication in patients with certain conditions.
Maybe you deemed it not therapeutically appropriate in this patient.
I don't have access to your notes, but I have a diagnosis, a patient history, and am currently speaking with our patient right now.
See, it's my job to make sure that what you write is appropriate.
Is complete.
Is effective.
Is actually correct.
You don't have to follow my suggestion(s) any more than I have to fill your prescriptions.
But you don't have to be a dick.
So here's what I'd send back:

You know what they call the person who graduated last in his class at Med School? Doctor.
Well I'm both a Pharmacist AND a Doctor so what's your superpower?
Care to follow the CMS recommendations now?
Do you need a second opinion?
As a Pharmacist AND a Doctor, I am fully licensed to provide you with one.
Oh, one more thing. If you were such a good doctor, wouldn't you already have known about this recommendation and put your patient on it?

(Yes. As I mentioned earlier, it may not be therapeutically appropriate for this particular patient. Maybe she tried and failed; had reactions; can't afford it. Whatever. As happens all too often with prescribers, they don't like being told what to do. Fortunately I've seen a shift over the last few years and love when all types of prescribers call to discuss treatments with me.)

Reminder: #DontBeADick

Monday, September 17, 2018

More Shot Thoughts

Random Thought Phor The Day. . .
CP: I need your help.
ME: What's up?
Myself: What do you need?
CP: A lead-in to my thought.
Me: What is it?
CP: <whispers to Me and Myself>
ME: Got it. Hey, what types of marketing do companies do for flu shots?
Myself: Let's see, there's TV, radio, internet, mobile apps, print in newspapers, circulars, signs in stores on the windows and counters, buttons on staff members, coupons, banners in front of stores, billboards, digital signs, some random dude dressed like a syringe standing out front jumping up and down.
ME: Oh yeah, the currently-out-of-work Liberty tax guy!
CP: Thanks. I'll take it from here.
Myself: It's your show.
CP: If you are a multi-billion dollar company and you spend millions of dollars on print advertising, digital advertising, TV advertising, multimedia advertising, and you STILL want your staff to ask "You want a flu shot with that", perhaps your marketing isn't worth it.
Save the money, give me more tech help and THAT in itself will generate more flu shots and mo money, mo money, mo money.
ME: Right on! Seriously, at this point, who doesn't know we offer flu shots?
Myself: Or that McDonald's has fries?

People will eventually not notice it thanks to #TheBlindnessOfUbiquity